DE102005032933A1 - Invention concerning implants - Google Patents

Abstract

It becomes a milling device and a method for improving the reosseointegration of or the treatment of bone areas around implants, preferably Dental implants, presented around. The core of the milling device according to the invention and the method constitutes the recognition that the reosseointegration then it speeds up if the preparation of the injured Area around the implant by a through the implant self-guided or in exact relation to this positioned milling device.

Description

The The present invention relates to an apparatus and a method for the reconstruction of peri-implant bone defects in patients with implants, in particular implants, which at least partially sticking out of bony parts, like dental implants. Among patients In the following, all living beings are understood, which in principle implants, especially dental implants.

In dental implants, an implant is anchored in the bone crest of patients. The implant usually consists of a cylindrical body, which externally (for anchoring in the bone) usually carries an external thread and tapers. At the opposite end, ie in the following consideration above, a tooth crown or other structure is then applied to the mostly cylindrical body. The cylindrical body has to above a recess, ie it is made up like a hollow cylinder. (please refer 1 ).

To the implantation of dental implants, this technique since approx. Known for 20 years and has been used increasingly for about 10 years will, now enter the dental Practice reinforced such problems, which mostly coincide with the contamination of the implant surface, e.g. due to bacterial infestation of the implant surface. The contamination the implant surface can already be at the onset of the implant or subsequently Contamination between implant and surrounding bone area be located gap. In particular, bacterial plaque, as they come out of the mouth known by humans and animals, carries over a Perümplantitis to break down the bone area around the implant. The loss this bone area then endangers in consequence the stability of the implant and guides due to the exposed areas of the implant usually to further Contamination of the implant surface.

Of the But loss of this bone area around the implant can be also caused by other causes, such as accidents.

disadvantage in the prior art

in the Prior art has been used to avoid loss of the implant or to avoid reinstatement (with concomitant Loss of healthy bone tissue) so far tried by a variety of Method, e.g. through controlled bone regeneration, the reosseointegration, i.e. the resettlement of bone tissue in the previously lost Bone area around the implant to perform. This is in to this day no known case has been shown to be fully satisfactory.

to Time is also tested procedures, parts of materials, mostly Bone parts, similar structure to arrange around an implant and mostly with soft tissue membranes, To fix films or other auxiliary devices, so as to build up the bone to realize an implant around. The disadvantage of this method is that several steps and therefore mostly painful Treatment steps are necessary and the bone structure often even not or only very slowly.

task The present invention is therefore an apparatus and a Method for solving this Specify the task.

Solution of task

These The object is achieved by the provision of a device according to claim 1 and a method according to claim 12 and 13.

The The essence of the invention is the experimental result obtained in some experiments, that the reosseointegration is particularly successful, if first the injured Area defined around the implant and completely removed and in the distal area then one, especially to the implant towards, form-fitting Replacement structure is introduced.

These Replacement structure is preferably an autologous bone graft won bone slice, if possible with a structure which is the structure of the area to be replaced equivalent. In the case of a dental implant, so should the replacement structure in the form of the bone slice thus of such a bone material be constructed, which is the structure of the alveolar ridge around the implant around corresponds. The replacement structure can of course also artificial Art, such as by tissue engineering obtained replacement bone, be.

In order to ensure the defined and as complete as possible removal of the damaged area around the implant, it has proved to be particularly useful to use a milling device according to the invention, which in one of its embodiments roughly resembles a trephine. The device according to the invention is characterized by guide means, which are designed so and cooperate with the implant that the milling device according to the invention in Relation is guided or positioned relative to the longitudinal axis of the implant, that the movement of the cutting elements of the milling device defined in relation to the longitudinal axis of the implant is performed. The guide means must be centrally located in the center of the milling device or in the center of the cutting elements.

So is guaranteed that the milling device according to the invention an exact and firmly defined in relation to the implant machining or / and removal of the desired Area around the implant allows around.

Just this ensures that subsequently used replacement structures exactly on the outer surface of the Implants are what concerns a fast reosseointegration of the implant -as well as the invention underlying research is absolutely necessary.

The Core of the method according to the invention to improve the reosseointegration forms the examination result, that possible closely or even under tension on an implant adjacent replacement structures the fastest and / or safest or / and most comprehensive reosseointegration of Implants, especially dental implants deliver.

• a) Entnahme eines Knochenbereiches um das Implantat herum, vorzugsweise unter Verwendung der erfindungsgemäßen Vorrichtung
• b) Entnahme einer diesem Bereich ähnlichen Ersatzstruktur, vorzugsweise aus demselben Patienten oder Auswahl einer der Struktur um das Implantat ähnlichen Ersatzstruktur aus den an sich oder aus dem Bereich des Tissue Engineering, bekannten Ersatzstrukturen
• c) Präparation einer um das Implantat herum passenden Struktur, vorzugseiner ringförmigen Struktur aus dieser Ersatzstruktur, vorzugsweise ausserhalb des Patientenkörpers,
• d) Einsetzung der Ersatzstruktur, vorzugsweise einer ringförmigen Ersatzstruktur und vorzugsweise vollumfänglich rund um das Implantat herum.

For this purpose, it is proposed according to the invention to carry out the following, principal steps:

• a) removal of a bone area around the implant, preferably using the device according to the invention
• b) Removal of a replacement structure similar to this region, preferably from the same patient or selection of a replacement structure similar to the structure around the implant from the replacement structures known per se or from the field of tissue engineering
• c) preparation of a structure that fits around the implant, preferably an annular structure made of this replacement structure, preferably outside the patient's body,
• d) insertion of the replacement structure, preferably an annular replacement structure and preferably completely around the implant.

In front the installation must be the contaminated area to be cleaned and disinfected.

In front the process of insertion or the process of insertion may also promoting reosseointegration Materials are introduced in the area previously removed areas.

Around a certain fixation of the replacement structure on the ground after the To achieve onset, it has proven to be particularly advantageous if provided on and / or fixed in the implant fixative is which over the outer dimensions of the implant protrudes and pressure on the replacement structure of exercises above. In the case that the implant has an internal thread, the Fixative similar a screw be executed with such a mother, which has a larger circumference than that of the outer periphery of the Implant. But the fixative can also with a clamping fit or with a screw, e.g. a grub screw or other detachable connections executed fastened to the implant be. After all is the fixative, most preferably biodegradable Material executed. The connection with the implant can also be called biodegradable adhesion accomplished be. Suitable adhesives or materials are from surgery, e.g. in the form of biodegradable threads etc. known.

To the replacement structure is preferably replaced with tissue covered by the patient.

For the step a) the device according to the invention is preferably used, since this exact preparation guaranteed around the implant.

For the step b) is preferably bone material of the same patient and particularly preferred the same structure as the ones around the implant is, elected. It has also been shown here that the replacement structure, in particular, if this is in the form of a bone layer, if possible be thin should, then then the revitalization and / or vascularization particularly fast he follows.

• i) eine Unterlage zur Auflage der Ersatzstruktur auf einer Unterlage aufweist,
• ii) Fixierungsmittel, vorzugsweise in Form von Stempeln und Schrauben oder Schraubzwingen zur Verbindung der Stempel mit der Unterlage, unter Klemmung der Ersatzstruktur aufweist,
• iii) den Zugriff für die erfindungsgemäße Fräsvorrichtung oder/und, insbesondere im Falle einer Ringscheibe als Ersatzstruktur, den Zugriff für einen Spiralbohrer und eine Trepanfräse zur Entnahme der inneren Region, welche später über das Implantat gestülpt werden soll bzw. zur kreisförmigen Begrenzung des äusseren Bereiches der Ringscheibe, ermöglicht, wobei die Unterlage zur Auflage der Ersatzstruktur erfindungsgemäß so ausgeführt ist, dass zumindest ein Teil der Führungsmittel der erfindungsgemäßen Fräsvorrichtung etwa durch Eindrehung des Führungsmittels in die Unterlage eine Fixierung innerhalb der Unterlage erfährt.

For step c) a milling or drilling template according to the invention is preferably used, which

• i) has a base for supporting the replacement structure on a base,
• ii) fixing means, preferably in the form of punches and screws or screw clamps for connecting the stamp with the pad, under clamping of the replacement structure,
• iii) the access for the inventive milling device and / or, in particular in the case of an annular disc as a replacement structure, the access for a twist drill and a trephine for removal of the inner region, which is to be later slipped over the implant or to the circular boundary of the outer region the annular disc allows, wherein the pad for supporting the replacement structure according to the invention is designed so that at least a part of the guide means of the milling device according to the invention by turning the guide means in the pad a fixation within the Un learns.

in the Fall of an annular disc and the use of a twist drill for Removing the inner region of the disc, is preferably a twist drill with Used stop, wherein the milling or drilling template so executed is that the stop of the twist drill by stopping at the fixing means the template the depth of depression of the drill bit in the template limited. Particularly preferred is a twist drill used, which has a smaller outer diameter than the outer diameter of the implant.

Especially However, preferred is the use of the milling device according to the invention, especially in the embodiment with two-piece guide. It will be first the replacement structure on the pad by the fixative the template is roughly fixed and subsequently the second guide means used to extract the inner region of the replacement structure and thus a guide for the milling device according to the invention in the subsequent process of outer limitation of To give replacement structure. In this case, the second guide means with smaller outer dimensions is too choose, as it is the outer circumference of the implant corresponds. Thus, the region exercises around the cut out or milled Inner region around by "slipping" over the implant a pressure on top of that, which improves the reosseointegration.

Around through the second guide means a very good guide for the to give subsequent use of the milling device according to the invention is the second guide means preferably to lead into the pad, so that there is another Fixation learns.

All Particularly preferably, the second fixing means to the outside Area of the cutting device or about an external thread, which is preferably carried out this way is that it is in the substitute structure and most preferably also turned into the pad of the drilling template and reaching out wide advance another fixation of the replacement structure at the Underlay and on the guide means allows.

Consequently offers the second guide an even more exact guidance the milling device according to the invention, especially for the subsequent operation of limiting the outer circumference the replacement structure.

Further advantageous embodiments of The invention will be described in the figures described below and in the following Text sections - without concluding be - described.

It show schematically:

1 : the situation of an implant ( 1 ) with a recess ( 1a ), which in a ridge ( 3 ) of a patient, wherein two damaged areas 2 . 2 ' arranged around the implant,

2 : the situation after removal of the damaged area and introduction of a replacement structure ( 11 ), wherein a fixative ( 12 ) was used,

3a , b: a first embodiment of the milling device according to the invention in a sectional view,

4a , b: a second embodiment of the device according to the invention in a sectional view,

5 : the situation of a severely damaged area around an implant area, where the alveolar ridge has already been dismantled and wide, upper areas of the implant are already exposed unprotected,

6a , b, c: a further embodiment of the device according to the invention in a sectional view,

7a , b: a sequence of the method for applying the device according to the invention in a sectional view,

8a , b, c: further exemplary embodiments of the device according to the invention in a sectional view,

9 : the drilling template according to the invention in a sectional view.

3a In the simplest embodiment, the milling device according to the invention has a guide means ( 21 ) which, in the case of an implant ( 1 ) with recess ( 1a ) in the upper area- has approximately the shape of a pin. In the case of a cylindrical recess ( 1a ), the guide means is designed as a cylindrical pin. In the upper region, the device has a connection piece for the attachment of a drive device and in the lower region is a milling / cutting region or a region with milling / cutting means ( 22 ) intended. In this embodiment, the guide means is made integral with the remainder of the milling device, having a circular milling edge of cutting or milling elements. In this embodiment, the guide means ( 21 ) with rotating guide of the milling device into the interior of a mostly open top implant.

3b : If the inner recess ( 1a ) of the implant is not sufficient for guidance, further, the upper portion of the implant encompassing guide means ( 21 ) intended. The milling / cutting means ( 22 ) can as in 3a be inwardly directed and have inwardly and / or outwardly directed cutting edges. 3b shows an embodiment in which the milling / cutting means inclined or / and beyond the area outer region of the other parts of the milling device protrude.

4a , b show further embodiments of the device, wherein 4a an example in which the milling device is made in two parts, wherein the guide means ( 21 ) engages again in the upper end of an implant but now designed with an internal thread with an external thread provided on the guide means. The guiding means ( 21 ) has inside a rotatably mounted in a bearing pin. The guide will, as in 4a shown screwed under left-hand rotation in the implant. The second part of the guidance ( 25 ) is designed so that this subsequently with the remaining components of the milling device via the pin of the guide means ( 21 ) is feasible. The milling device may subsequently be rotated with very close guidance relative to the longitudinal axis of the implant with connection to a drive to the right to remove damaged bone around the implant by milling and / or cutting. 4b shows a further embodiment in which the second part of the guide means ( 25 ) by a thread with the pin of the first part ( 21 ) is rotatably connected. This improves the leadership. The outer area around the pin, which carries the bearing for the pin, serves as a stop for limiting the penetration depth. By adding nuts or washers (not shown) in the area above the bearing, the stop height can be varied. To further increase the stability of the guide, a combination of the guide means ( 21 ) out 4a with the guide means 3b be provided. Also, the bearing above or outside the upper recess of the implant ( 1a ) be provided.

5 shows a situation in which a large part of the upper area has been damaged around the implant, so that large parts of the upper implant surface are unprotected. The outer bony area around the implant is so far damaged that it is to be feared that the implant is too loosened when guiding the milling device. Also in this case, the guide means of the milling device according to the invention is designed in two parts.

In 5 and 6a is the first part ( 21 ) designed in such a way that, in interaction with the implant, it is either inserted into this or / and not drawn in - this partially surrounding in the upper region, essentially as a mere positioning element for the second part ( 25 ) serves.

In 6a is the second part ( 25 ) is configured such that in the upper region it has a part which at least partially surrounds the first part of the guide means and in the lower region has a substantially cylindrical cutting body. If the upper portion of the second part of the guide means is rotated, the cutting body moves to form a solid anchoring -vermittels provided anchoring means ( 23 ), such as by thread-like cutting edges in the Aussenbereich- the cutting means in the surrounding bone surrounding the implant area.

After sufficiently deep and / or firm anchoring, the first part of the guide means, which cooperates with the implant for positioning the second part of the guide means, can be removed for all further working steps, as in 6a indicated.

Consequently be through the further steps, which essentially the removal of the damaged ones Bone parts in the area around the implant essentially concern do not transfer any further mechanical effects to the implant. In this case, the second part of the guide means formed with the cutting means so that after removal of the cutting means -something by rotation of the cutting means in the other direction than at the anchorage possible little bone material in the area between the anchoring position the second part of the guide means and the implant remains. Therefore, the inner dimensions should be the cutting means region of the second part of the guide means essentially the outer ones Dimensions of the implant correspond.

The second part of the guide means has approximately at the top of other guide means ( 27 ), in the form of a hollow cylinder, for guiding the remainder ( 26 ) of the milling device according to the invention.

6b and 6c shows a further embodiment in which the area of the guide means 25 which is the guiding agent 21 surrounds detachably - approximately by a thread - with the rest of the guide means ( 25 ) connected is. This embodiment has advantages in the event that the guide means ( 21 ) can not be removed and by the subsequent steps of the removal of the damaged area around the implant too large mechanical loads on the means ( 21 ) and / or the implant are transferred.

In this case, the area of the guiding means ( 25 ) around the means ( 21 ) are exchanged around and replaced by one which the interaction with the guide means ( 21 ), in which a further opening for the guide means ( 21 ) is provided.

7a shows in the sequence a), b) and c) how successively the guiding agent ( 21 ), the second guiding means ( 25 ) and subsequently the first guide means ( 21 ) is taken.

7b shows the further steps d), e) and f), ie the attachment of the remainder of the milling device ( 26 ) guided by the second guide means ( 25 ), the removal e) after the removal of the damaged areas by the milling device and the removal f) of the second guide means ( 25 ), in each case the correct directions of rotation are to be observed, so that not the means ( 25 ), to guide the milling device, is removed too soon.

8a shows a further advantageous embodiment of the second guide means ( 25 ). In this example, the guide means is without external anchoring means ( 23 ) designed so that the milling device ( 26 ) very close to the middle ( 25 ). This is made possible by the fact that the cutting means ( 22 ) are executed even in the form of a thread or other anchoring means.

8b and c show further embodiments of the cutting means ( 22 ) in the form of the wall of the milling device ( 26 ) outstanding and outwardly inclined cutting / milling or in a simple tapered shape.

9 shows a drilling template for use with a conventional (shown) or the milling device according to the invention. When using the milling device according to the invention, preferably with the guide means ( 25 ), as in the embodiment according to 8a with non-external anchoring means, a particularly preferred embodiment of the milling device in the upper region of a stop (not shown), which causes a limitation of the penetration depth in the drilling template and thus in the starting structure for the replacement structure. The outer diameter of the milling device according to the invention should be chosen slightly smaller than the outer diameter of the implant, so that the replacement structure exerts stress on the surface of the implant.

The use of the milling device according to the invention with anchoring means has the advantage that, when the anchoring means ( 25 ) in the initial structure of the replacement structure and, moreover, in the document ( 41 ) of the template ( 40 ), a particularly accurate fixation of the replacement structure takes place. The subsequent operation of limiting the outer circumference of the starting structure is then carried out under approximately the same guiding or positioning conditions as the removal of the damaged area around the implant, whereby a particularly high precision is achieved.

In a further embodiment (not shown), it is provided for the cases of the presence of a cylindrical implant, but of a region which is not nearly circular, damaged, as a second guiding means (FIG. 25 ) provide a cylindrical guide means with cutting / milling and / or anchoring means, but the rest of the device according to the invention ( 26 ) is preferably designed so that the peripheral line of the cutting / milling elements of the device ( 26 ) corresponds to the perimeter of the damaged area. In this case, the cutting / milling elements have their own, associated with these drives.

In a further embodiment, not shown, it is provided that the guide means (FIG. 21 ) for use in or on the implant in such a way that, after introduction of the replacement structure, this fixation agent ( 12 ) for the replacement structure, the latter preferably being made of biodegradable material and more preferably so that the fixative ( 12 ) is applied vertically, approximately parallel to the longitudinal axis of the implant, pressure on the replacement structure.

It is immediately apparent to the person skilled in the art that the here as second guiding means ( 25 ) means can also be used as such as a milling device, as in the 3a , Federation 4a , b shown.

It is also immediately apparent to the person skilled in the art that further, the inner guiding means ( 21 . 25 ) or ( 26 ) encompassing guide means for guiding the milling / cutting elements can be provided.

It is obvious to a person skilled in the art in particular that the milling device described here is provided with guide means ( 21 . 25 . 26 ) can also find advantageous application in non-rotati onsymmetrischen implants in the sense of the task.

It is also immediately apparent to the person skilled in the art that the embodiments of the milling device ( 20 . 21 . 25 . 26 ) alone or in connection with the template ( 40 ) in each case an inventive In Set of instruments for the reosseointegration of implants.

1

implant

1a

Upper Recess in the implant

2, 2 '

Damaged areas around the implant

3

Upper Border of the tooth crest (covered with gums)

10

output structure for replacement structure

11

Replacement structure, usually in the form of a bone ring

12

fixative for replacement structure, e.g. in the form of a screw

20

Inventive milling device

21

guide means

22

cutting or milling area or agent

23

Anchoring means in the form of cutting edges of a thread

25 26

second and third part of the guide

27

Further guide means

40

template

41

document

42

fixative the template

50

twist drill

Claims (13)

Milling device for removing damaged structures of a human or animal tissue around an implant, which is inserted into the bones of the animal, in particular a dental implant, comprising milling / cutting means, characterized in that the device comprises guide means ( 21 . 25 . 25 ), which are designed so and are designed to cooperate with the implant that the milling device according to the invention is guided or positioned in relation to the longitudinal axis of the implant, that the movement of the milling / cutting means ( 22 ) of the milling device ( 20 ) defined in relation to the longitudinal axis of the implant is guided. Device according to claim 1, characterized in that the guide means ( 21 . 25 . 26 ) engaging in a recess of the implant or an encompassing an upper part of the implant. Apparatus according to claim 1 to 2, characterized that the guiding means rotatably engaging in an upper recess or an upper portion of the implant are rotatably encompassing executed. Apparatus according to claim 1 to 3, characterized that the guiding means solvable connected to the implant. Device according to Claims 1 to 4, characterized that the guidance means over a Thread are executed connected to the implant. Apparatus according to claim 1 to 5, characterized in that the guide means rotatable, for example via a bearing with the cutting or milling means ( 22 ) of the device ( 20 ) are connected. Device according to Claims 1 to 6, characterized that several at least in an upper area encompassing Guiding means are provided, which parallel to the longitudinal axis of Implantates are made positionable. Device according to Claims 1 to 7, characterized in that the device has means for limiting the cutting depth, for example through attacks at the guide means, having. Apparatus according to claim 1 to 8, characterized in that the device in the lower region of the guide means anchoring means ( 23 ) having. Instrument set consisting of an upper several of the above devices, being the elements of the sentence differ in that these different outer diameter the cutting / milling agent (22). Drilling template for use with the milling device according to the invention according to claim 1 to 9, comprising: - a pad to support having the replacement structure on a base, Fixative, preferably in the form of punches and screws or screw clamps for connecting the stamp with the pad, under clamping of Having replacement structure, - the Access for the milling device according to the invention allows wherein the pad for supporting the replacement structure according to the invention is designed so that at least part of the guide means the milling device according to the invention about by turning the guide means in the pad undergoes a fixation within the pad. A method for reosseointegration of an implant inserted into a human or animal bone, characterized by the following, principal steps: a) removal of a bone area around the implant, preferably using the device according to the invention, b) removal of a replacement structure similar to this area, preferably from the same Patients or selection of one of the structure around the implant-like replacement structure known per se or from the field of tissue engineering, Er d) insertion of the replacement structure, preferably an annular replacement structure and preferably completely around the implant, wherein in step c) the milling device according to the invention is used for the preparation of the replacement structure outside the body. Use of a milling device according to one of claims 1 to 9, an instrument set according to claim 10 or a drilling template according to Claim 11 in methods for reosseointegration or treatment of implants.